Managed Care - January 2009 - (Page CB-B5)

RSV-related hospitalization per 100 children <6 months of age sive and proactive RSV management program for infants younger than 1 year at high risk of RSV infection, with an emphasis on preterm infants, can help reduce NICU admissions and RSV hospitalizations and their associated costs. Optimally, such a program should ensure the care of an infant prior to hospital discharge and throughout the infant’s first RSV season, which can be determined by accessing local RSV epidemiology data. Case management should be encouraged. Hospital case managers can quickly identify and evaluate high-risk infants. Managed care case managers can facilitate the prompt and smooth transition of these infants from the hospital or NICU setting to the clinical setting or home so that RSV management can continue. Parent education is also important, and parents and other caregivers should be counseled on the importance of hand washing and other sanitation safeguards in the home. Summary Severe RSV disease, manifested as bronchiolitis or pneumonia, is the leading cause of hospitalization of infants younger than 1 year of age in the United States. Infants born 35 weeks or less GA are particularly at high risk of severe RSV disease, which may result in frequent NICU admissions or long hospital stays and additional health care utilization over the first 12 months of life. This care is costly — infants 33 to 36 weeks GA with a history of RSV hospitalization incur costs that are nearly 5 times as much as costs for 33 to 36 weeks GA infants with no history of RSV hospitalization. FIGURE 5 RSV hospitalizations in Tennessee Medicaid infants* 60 50 40 30 20 56.3 12.1 10 0 BPD CHD 9.4 8.2 8.0 4.4 ≤28 wks 29 to <33 33 to <36 GA wks GA wks GA Lowrisk** * Data derived from a retrospective analysis of 3,553 hospitalizations for RSV-related illness in children <3 years of age enrolled in the Tennessee Medicaid system between July 1989 and June 1993. ** Low-risk defined as children born at term with no underlying medical conditions. BPD=bronchopulmonary dysplasia, CHD=congenital heart disease, GA=gestational age. Source: Adapted from Boyce 2000 FIGURE 6 Effects of prematurity on RSV-related hospital resource use and outcomes* Double hospital LOS Double ICU LOS Triple intubation rate 10 8 Days 6 4 2 0 Full term (n=215) 4.1 days 8.4 daysa 40 Percentage 7.7 daysa 3.8 days 30 20 12.1% 10 38.7%a 33–35 wks GA (n=31) Full term (n=215) 33–35 wks GA (n=31) Full term (n=215) 33–35 wks GA (n=31) (P<.0001)b (P=.021)b (P=.002)b ICU=intensive care unit, LOS=length of stay. * Based on a retrospective multicenter study that measured the severity of illness in 304 infants aged ≤1 year who were admitted to the hospital with confirmed RSV from April 1995 to September 1996. a Statistically significant difference from full-term infants (Duncan multiple range test). b P values derived from a comparison of 4 GA groups (≤32 weeks GA, 33–35 weeks GA, 36 weeks GA, ≥37 weeks GA). Adapted from Horn 2003 5

Table of Contents Feed for the Digital Edition of Managed Care - January 2009

Managed Care - January 2009 Editor's Memo Contents Legislation & Regulation News and Commentary Medication Management Compensation Monitor Health Care's Disruptive Innovations Q&A With Clayton Christensen 'Disruption' May Be Plans' Best Bet Avoid the PBM Rebate Trap HealthPartners Puts Diabetes on Notice Formulary Files Plan Watch Tomorrow's Medicine Ad Index Outlook Unmet Needs in the Management of Plaque Psoriasis Impact of RSV: Implications for Managed Care

Managed Care - January 2009

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